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Early glycaemic control in metformin users receiving their first add-on therapy: a population-based study of 4,734 people with type 2 diabetes.
Diabetologia 2015; 58(10):2247-53D

Abstract

AIMS/HYPOTHESIS

The aims of this work were to assess glycaemic control in metformin users receiving their first add-on glucose-lowering therapy and to examine the real-life effectiveness of different add-on drugs.

METHODS

We carried out a population-based cohort study using healthcare databases in northern Denmark during 2000-2012. We included 4,734 persons who initiated metformin monotherapy and added another glucose-lowering drug within 3 years. Attainment of recommended HbA1c goals within 6 months of add-on was investigated, using Poisson regression analysis adjusted for age, sex, baseline HbA(1c), diabetes duration, complications and Charlson Comorbidity Index.

RESULTS

Median metformin treatment duration at intensification was 12 months (interquartile range [IQR] 4-23 months) and pre-intensification HbA(1c) was 8.0% (IQR 7.2-9.2%) (64 [IQR 55-77] mmol/mol). Median HbA(1c) dropped 1.2% (13 mmol/mol) with a sulfonylurea (SU) add-on, 0.8% (9 mmol/mol) with a dipeptidyl peptidase-4 (DPP-4) inhibitor, 1.3% (14 mmol/mol) with a glucagon-like peptide-1 (GLP-1) receptor agonist, 0.9% (10 mmol/mol) with other non-insulin drugs and 2.4% (26 mmol/mol) with insulin. Compared with SU add-on, attainment of HbA(1c) <7% (<53 mmol/mol) was higher with GLP-1 receptor agonists (adjusted RR [aRR] 1.10; 95% CI 1.01, 1.19) and lower with DPP-4 inhibitors (aRR 0.94; 95% CI 0.89, 0.99), other drugs (aRR 0.86; 95% CI 0.77, 0.96) and insulin (aRR 0.88; 95% CI 0.77, 0.99). The proportion of metformin add-on users who attained HbA(1c) <7% (<53 mmol/mol) increased from 46% in 2000-2003 to 59% in 2010-2012, whereas attainment of HbA(1c) <6.5% (<48 mmol/mol) remained 30% among patients aged <65 years without comorbidities.

CONCLUSIONS/INTERPRETATION

Among early type 2 diabetes patients receiving their first metformin add-on treatment, HbA(1c) reduction with different non-insulin drugs is similar to, and comparable with, that observed in randomised trials, yet 41% do not achieve HbA(1c) <7% (<53 mmol/mol) within 6 months.

Authors+Show Affiliations

Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark. rwt@clin.au.dk.Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark.Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark.Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark.Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark.Novo Nordisk Scandinavia AB, Ørestad, Copenhagen, Denmark.Novo Nordisk Scandinavia AB, Ørestad, Copenhagen, Denmark.Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26277380

Citation

Thomsen, Reimar W., et al. "Early Glycaemic Control in Metformin Users Receiving Their First Add-on Therapy: a Population-based Study of 4,734 People With Type 2 Diabetes." Diabetologia, vol. 58, no. 10, 2015, pp. 2247-53.
Thomsen RW, Baggesen LM, Søgaard M, et al. Early glycaemic control in metformin users receiving their first add-on therapy: a population-based study of 4,734 people with type 2 diabetes. Diabetologia. 2015;58(10):2247-53.
Thomsen, R. W., Baggesen, L. M., Søgaard, M., Pedersen, L., Nørrelund, H., Buhl, E. S., ... Johnsen, S. P. (2015). Early glycaemic control in metformin users receiving their first add-on therapy: a population-based study of 4,734 people with type 2 diabetes. Diabetologia, 58(10), pp. 2247-53. doi:10.1007/s00125-015-3698-1.
Thomsen RW, et al. Early Glycaemic Control in Metformin Users Receiving Their First Add-on Therapy: a Population-based Study of 4,734 People With Type 2 Diabetes. Diabetologia. 2015;58(10):2247-53. PubMed PMID: 26277380.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Early glycaemic control in metformin users receiving their first add-on therapy: a population-based study of 4,734 people with type 2 diabetes. AU - Thomsen,Reimar W, AU - Baggesen,Lisbeth M, AU - Søgaard,Mette, AU - Pedersen,Lars, AU - Nørrelund,Helene, AU - Buhl,Esben S, AU - Haase,Christiane L, AU - Johnsen,Søren P, Y1 - 2015/08/16/ PY - 2015/04/27/received PY - 2015/06/26/accepted PY - 2015/8/17/entrez PY - 2015/8/19/pubmed PY - 2016/6/28/medline KW - Antidiabetic agents KW - Clinical quality KW - Comparative effectiveness KW - Glucose-lowering therapy KW - Glycaemic control KW - HbA1c KW - Hypoglycaemic agents KW - Metformin KW - Pharmacoepidemiology KW - Type 2 diabetes SP - 2247 EP - 53 JF - Diabetologia JO - Diabetologia VL - 58 IS - 10 N2 - AIMS/HYPOTHESIS: The aims of this work were to assess glycaemic control in metformin users receiving their first add-on glucose-lowering therapy and to examine the real-life effectiveness of different add-on drugs. METHODS: We carried out a population-based cohort study using healthcare databases in northern Denmark during 2000-2012. We included 4,734 persons who initiated metformin monotherapy and added another glucose-lowering drug within 3 years. Attainment of recommended HbA1c goals within 6 months of add-on was investigated, using Poisson regression analysis adjusted for age, sex, baseline HbA(1c), diabetes duration, complications and Charlson Comorbidity Index. RESULTS: Median metformin treatment duration at intensification was 12 months (interquartile range [IQR] 4-23 months) and pre-intensification HbA(1c) was 8.0% (IQR 7.2-9.2%) (64 [IQR 55-77] mmol/mol). Median HbA(1c) dropped 1.2% (13 mmol/mol) with a sulfonylurea (SU) add-on, 0.8% (9 mmol/mol) with a dipeptidyl peptidase-4 (DPP-4) inhibitor, 1.3% (14 mmol/mol) with a glucagon-like peptide-1 (GLP-1) receptor agonist, 0.9% (10 mmol/mol) with other non-insulin drugs and 2.4% (26 mmol/mol) with insulin. Compared with SU add-on, attainment of HbA(1c) <7% (<53 mmol/mol) was higher with GLP-1 receptor agonists (adjusted RR [aRR] 1.10; 95% CI 1.01, 1.19) and lower with DPP-4 inhibitors (aRR 0.94; 95% CI 0.89, 0.99), other drugs (aRR 0.86; 95% CI 0.77, 0.96) and insulin (aRR 0.88; 95% CI 0.77, 0.99). The proportion of metformin add-on users who attained HbA(1c) <7% (<53 mmol/mol) increased from 46% in 2000-2003 to 59% in 2010-2012, whereas attainment of HbA(1c) <6.5% (<48 mmol/mol) remained 30% among patients aged <65 years without comorbidities. CONCLUSIONS/INTERPRETATION: Among early type 2 diabetes patients receiving their first metformin add-on treatment, HbA(1c) reduction with different non-insulin drugs is similar to, and comparable with, that observed in randomised trials, yet 41% do not achieve HbA(1c) <7% (<53 mmol/mol) within 6 months. SN - 1432-0428 UR - https://www.unboundmedicine.com/medline/citation/26277380/Early_glycaemic_control_in_metformin_users_receiving_their_first_add_on_therapy:_a_population_based_study_of_4734_people_with_type_2_diabetes_ L2 - https://dx.doi.org/10.1007/s00125-015-3698-1 DB - PRIME DP - Unbound Medicine ER -